Systolic Arterial Pressure Values Research Articles

Hemodynamic effects of etomidate anesthesia induction in diabetic and non-diabetic patients: Importance of heart rate variability in early detection of cardiac autonomic dysfunction

Aims: Cardiovascular diseases represent the primary cause of perioperative morbidity among diabetic patients. Etomidate, an anesthetic agent with minimal cardiovascular effects, is commonly used in these patients. Diabetic patients often experience cardiovascular autonomic neuropathy, a severe complication of diabetes. In recent years, measuring heart rate variability has become increasingly important for early detection of cardiac autonomic dysfunction. The aim of this study was to compare the hemodynamic effects of etomidate anesthesia induction between diabetic and non-diabetic patients. Methods: This was a prospective randomized study that enrolled consecutive ASA I-III patients scheduled for various elective surgeries under general anesthesia. The patients were divided into two groups: Group D (diabetic, n = 21) and Group ND (non-diabetic, n = 21). Heart rate variability analyses were performed using a Norav-800 Holter on the day before surgery. On the day of the operation, after premedication and monitoring, general anesthesia was induced with etomidate. Hemodynamic parameters were measured before induction (T1), after induction (T2), and 2 min (T3), 5 min (T4), and 10 min (T5) after endotracheal intubation. Hemodynamic changes and heart rate variability were compared between the two groups. Results: Group D showed a statistically significant decrease in systolic arterial pressure values at T2, T4, and T5 compared to baseline values (p < 0.001), while Group ND showed no significant differences in any period. Diastolic blood pressure decreased significantly in Group D compared to baseline values in the preintubation period (p < 0.001), but there was no significant change in Group ND. Heart rate did not significantly differ between the two groups during any measurement period, and there was no correlation between heart rate variability and hemodynamic changes. Conclusion: The results suggest that etomidate anesthesia induction provides hemodynamic stability in patients with type 2 diabetes mellitus. Despite its potential utility, heart rate variability measured during resting conditions may not provide sufficient diagnostic accuracy for predicting the presence of autonomic neuropathy, particularly in individuals with diabetes mellitus.Therefore, additional measures may be needed for early detection of cardiac autonomic dysfunction in these patients.

Pregnancy restores altered sympathetic vasomotor modulation and parasympathetic cardiac modulation in hypertensive rats

Hypertension is associated to impaired baroreflex sensitivity (BRS). In spontaneously hypertensive rats (SHR), pregnancy reduces blood pressure, and this effect has been associated to increase nitric oxide (NO) bioavailability. Increased NO bioavailability has been linked to improve BRS in hypertensive animals. Therefore, we hypothesize that pregnancy improves the BRS in SHR. We performed experiments to evaluate the vasomotor and cardiac autonomic modulation, also to evaluate the BRS at baseline conditions (spontaneous) and after phenylephrine (PE) and sodium nitroprusside (SNP) administrations in non-pregnant (NP) and pregnant (P) Wistar rats and SHR. Beat-to-beat time series with systolic arterial pressure values were generated and processed by Fast Fourier Transform (spectral analysis). Next, spectra were integrated into low-frequency (LF) band and had their power taken as an index of sympathetic modulation on arterial pressure. Reduced mean arterial pressure was observed in P-groups when compared to NP matched rats, although we did not observe alterations in heart rate (HR). In SHR-NP, spectral analysis revealed altered cardiovascular autonomic modulation when compared to the other groups. However, in SHR-P the autonomic parameters were similar to those observed in Wistar-NP, suggesting that pregnancy changed autonomic modulation. BRS assessed by means of the sequence method was found similar in P-groups. Pregnancy reduced the BRS during hypotension in Wistar. BRS assessed with PE and SNP administration was found lower in SHR-NP as compared to Wistar-NP, and it was not altered by pregnancy. In conclusion, pregnancy did not improve the BRS in SHR, but normalized altered sympathetic vasomotor modulation in SHR.

English

Introduction: Functional physical capacity is indirectly associated with mortality, and may be compromised after a cardiovascular event, hence the importance of considering its prognostic factors during treatment in heart disease patients. Aim: To identify the prognostic factors of functional physical limitation in patients with myocardial revascularization for acute coronary syndrome. Material and method: A retrospective analysis was carried out of 29 medical records taken from patients submitted to a stress test (Bruce, modified Bruce) after myocardial revascularization during the months of January to December 2019. For the statistical analysis, a univariate and multivariate logistic regression (Odds Ratio-OR) was performed, as well as a simple linear regression analysis between the variables of interest. Results: the analyzed patients had a mean age of 60 ± 9,2 years, and 76% were men. The presence of systemic arterial hypertension (SAH), lower values of Maximum Heart Rate (HR) (ß = 0,112; CI: 0,074, 0,149; p <0.001), high values of Systolic Arterial Pressure (SBP) (ß = - 0,083; CI 95%: -0,152, -0,014; p <0.020), and a greater number of risk factors (ß = - 1,580; CI 95%: -2,456-0,868; p <0.001), are considered predictors of functional limitation (<7 METs). Conclusion: The presence of SAH, a greater number of risk factors, as well as high maximum SBP levels and lower maximum HR values reached during the stress test, were shown to be prognostic factors of functional limitation in subjects revascularized for ACS

Effects of propofol, desflurane and isoflurane on perioperative blood glucose level in intracranial mass operation: A randomized controlled trial

The aim of this study is to compare the effects of the propofol, desflurane and isoflurane on blood glu-cose levels in cranial surgery. Ninety, ASA I-II patients aged between 18-60 years old were scheduled for study. Induction was per-formed with fentanyl, propofol and cisatracurium in all patients. Anaesthesia was maintained using propofol 4-6 mg/kg/h in propofol group (Group P), desflurane and isoflurane 0.5-1 MAC in group desflurane (Group D) and group isoflurane (Group I). Remifentanil infusion was applied 0.5 µg/kg/min in all groups. Plasma glucose (PG) levels, systolic arterial pressure (SAP), diastolic arterial pressure, mean arterial pressure and heart rate measured. In the 1st, 2nd and 5th hour, PG levels were significantly lower in group P than group D. In the 2nd and 3rd hour, PG levels were significantly lower in group P than group I (p <0.05). In addition, SAP values in group D were found to be significantly lower than group P and group I. With this study, it was concluded that total intravenous anesthesia with propofol infusion in intracranial mass surgery is more effective than inhalation anesthesia such as desflurane and isoflurane in preventing the hyperglycemic response caused by surgical stress.

Systolic Blood Pressure in Anesthetized Dogs - Agreement between Measurements by Two Noninvasive Monitors

Background: The oscillometric monitor is a noninvasive method used for measuring blood pressure in dogs and cats. Despite widely used, there is a large variability in the accuracy of oscillometric monitors, which may also be influenced by the location of the blood pressure cuff. The Doppler ultrasound is another non-invasive method that was shown to measure blood pressure with good accuracy and precision in small animals. The present study aimed to determine the agreement between systolic arterial pressure (SAP) measured by the Prolife P12 oscillometric monitor with two cuff locations and the Doppler ultrasound in anesthetized dogs.Materials, Methods & Results: Dogs scheduled for routine anesthetic procedures were included in the study, which was carried out in two phases. In Phase 1, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor with the cuff placed at the thoracic limb for both methods. In Phase 2, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor, with the cuff placed at the thoracic limb for the Doppler and at the base of the tail for the P12. The cuff width corresponded to approximately 40% of limb or tail circumference. On all occasions, three consecutive measurements of SAP were recorded, followed by a single measurement of SAP by the P12, and then other three measurements were performed with the Doppler. The arithmetic mean of the six SAP measurements with the Doppler was compared with the SAP value measured by the P12 monitor (paired measurements). Agreement between SAP values measured by the Doppler and the P12 monitor was analyzed by the Bland Altman method for calculation of the bias (Doppler – P12) and standard deviation (SD) of the bias. The percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg and Pearson’s correlation coefficients were also calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. A total of 33 dogs were included in Phase 1 and 15 were included in Phase 2. During Phases 1 and 2, 179 and 87 paired measurements were recorded, respectively. Most of the measurements were recorded during normotension (SAP = 90-130 mmHg): 113/179 in Phase 1 and 52/87 in Phase 2. The bias (± SD) for Phases 1 and 2 were -2.7 ± 14.1 mmHg and 7.2 ± 25.8 mmHg. The percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: Phase 1, 61% and 83%; Phase 2, 41% and 70%. Correlation coefficients were 0.81 and 0.67 for Phases 1 and 2, respectively. According to the ACVIM criteria, maximum values accepted for bias are 10 ± 15 mmHg, the percentages of differences ≤ 10 mmHg and ≤ 20 mmHg should be ³ 50% and ³ 80%, respectively, and the correlation coefficient should be ³ 0.9. Discussion: When the blood pressure cuff was placed at the thoracic limb, SAP values measured by the P12 monitor met most of the ACVIM criteria, demonstrating good agreement with SAP values measured by the Doppler. The only requirement not met was the correlation coefficient which was 0.81 whereas the recommended is ³ 0.9. Conversely, when the cuff was placed at the base of the tail, SAP values measured by the P12 monitor did not meet most of the ACVIM criteria indicating that, in anesthetized dogs, SAP measurements with the P12 monitor should be performed with the cuff placed at the thoracic limb. One limitation of this study was that most measurements fell in the normotensive range and the results should not be extrapolated for hypotensive and hypertensive conditions. In conclusion, the Prolife P12 oscillometric monitor demonstrated good agreement with SAP values measured by the Doppler and provides acceptable values in normotensive anesthetized dogs.Keywords: arterial blood pressure, nonivasive blood pressure, anesthetic monitoring.Título: Pressão arterial sistólica em cães anestesiados - concordância entre mensurações por dois métodos não invasivosDescritores: pressão arterial, pressão arterial não invasiva, monitoração anestésica.

Selection of baseline blood pressure to guide management of hypotension during spinal anaesthesia for caesarean section

IntroductionRecommendations on vasopressor management during caesarean section under spinal anaesthesia suggest maintaining systolic arterial pressure ≥90% of an accurately measured baseline value. The baseline is often taken as the first reading in the operating room. We hypothesise that this reading may not reflect an accurate baseline value. MethodsA retrospective case note review of 300 non-hypertensive women undergoing caesarean section with neuraxial anaesthesia, including spinal anaesthesia for elective delivery (n=100), and spinal (n=100) and epidural top-up anaesthesia (n=100) for emergency delivery. Systolic arterial pressure values recorded at various time points between the last antenatal visit and the first blood pressure value recorded in the operating room were compared. ResultsThere was a stepwise and significant increase in systolic arterial pressure over three time points (last antenatal clinic, morning of surgery, operating room) before elective caesarean section (all P <0.001). In women having emergency caesarean under spinal anaesthesia, a stepwise increase over four time points (last antenatal clinic, first reading in labour, final reading in labour, operating room) was observed. A similar trend was seen over these time points for women having emergency caesarean under epidural top-up, although the systolic blood pressure did not rise during labour. ConclusionsUsing the initial blood pressure reading in the operating room as the baseline value may lead to unnecessary vasopressor use and hypertension. Prospective research is required to clarify which reading represents the most accurate baseline to maintain homeostasis and reduce the hypotensive sequelae of neuraxial anaesthesia for both the mother and fetus.

Hypotension during hip fracture surgery and postoperative morbidity

BackgroundHip fracture is a growing healthcare challenge, with 6–8% 30-day mortality and 20–30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity.ObjectiveWe evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity.MethodsA retrospective analysis was carried out on n = 52 patients undergoing hip fracture surgery between January and June 2017. Measurements of patients’ intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia, logged electronically through an anaesthesia information management system, were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP < 75 mmHg, MAP < 55 mmHg, SAP ≤ 80% admission baseline or SAP ≤ 80% pre-induction baseline). Univariate and bivariate descriptive statistics were generated for all relevant variables. With multivariable regression models containing known predictors, cumulative duration of hypotension was correlated with postoperative comorbidities as quantified by the Clavien-Dindo and Comprehensive Complication Indices.ResultsMean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia. Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP < 80% pre-induction value adjusted to gender, age and the Charlson Comorbidity Index was associated with progression to a higher Clavien-Dindo classification (odds ratio 1.020 per additional minute; 95% CI 1.008–1.035; P = 0.003).ConclusionsIn this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.

Comparative analysis of the effect of various types of combined anaesthesia on the central hemodynamics in laparoscopic cholecystectomy

Introduction. At present, laparoscopic cholecystectomy is a type of minimally invasive intervention, mostly performed for the treatment of patients with cholelithiasis. A large number of procedures worldwide taken into consideration, the issue of the effect of various anaesthesia types on the central hemodynamics becomes increasingly important, since its state often determines possible complications of surgical intervention. Aim. Objective is to assess the effect of various combined anaesthesia types on the central hemodynamics in laparoscopic cholecystectomy. Material and methods. Examination included 119 patients (aged between 20 and 82) who had undergone surgery for acute cholecystitis. Laparoscopic cholecystectomy with the use of carboxy peritoneum (CP) was performed in all cases. Depending on the type of anaesthesia, patients were divided into 3 groups: Group 1 (n = 44) – those who were operated on under combined general intravenous anaesthesia (CGIA); Group 2 (n = 44) – the surgery was performed under combined inhalation anaesthesia (CIA) with sevoflurane; Group 3 (n = 31) – laparoscopic cholecystectomy was performed under combined spinal anaesthesia (CSA) with 0.5% bupivacaine. Subject to comparison were the indices of hemodynamic profile and intra-operative analgesia that was judged on the amount of narcotic analgesics used. The research was authorized by the Bio-ethical Commission of Kyiv City Hospital ? 4. Permission number is U22072016. All patients gave prior written permission to participate in this study. Results. Average systolic arterial pressure in the groups with carbon dioxide insufflated into abdominal cavity: Group 1 – 137.5 ± 18.9 mm Hg; Group 2 – 136.6 ± 17.7 mm Hg; Group 3 – 115.0 ± 13.7 mm Hg. In Group 3, systolic arterial pressure values differed statistically from those in groups 1 and 2 (p &lt; 0.001). Average systolic arterial pressure under carboxy peritoneum: Group 1 – 101.7 ± 14.1 mm Hg; Group 2 – 100.0 ± 12.2 mm Hg; Group 3 – 86.7 ± 10.4 mm Hg. Average doses of fentanyl used for anaesthesia in the groups were: Group 1 – 11.7 mcg/kg; Group 2 – 10.9 mcg/kg; Group 3 – 6.28 mcg/kg. Conclusions. The changes of central hemodynamics in the patients who had undergone combined spinal anaesthesia for laparoscopic cholecystectomy were found to be the least as compared with combined prevenous and endotracheal anaesthesia.

Effects of ketofol and propofol on intubation conditions and hemodynamics without the use of neuromuscular blockers in patients undergoing tympanomastoidectomy

The effect of ketofol, a mixture of ketamine and propofol in various ratios, on hemodynamic, for intubation without the use of neuromuscular blockers, has not been elucidated in patients undergoing tympanomastoidectomy. We evaluated the effects of ketofol and propofol on intubation conditions and hemodynamic without the use of a neuromuscular blocker. The prospective randomized, double-blinded study was scheduled for tympanoplasty or mastoidectomy. The patients were divided randomly into a propofol group (Group P) and a ketofol group (Group KP). Intubation conditions, changes in hemodynamics, HR, MAP, systolic arterial pressure (SAP), and SpO2 values were recorded before induction, after induction, after intubation, and at 3-min intervals during the first 30 min, 5-min intervals for the next 30 min, and 10-min intervals after that. In the intragroup evaluation, SAP, DAP, MAP and HR values were lower in both groups compared to the baseline values. Hemodynamic values were significantly lower in Group P than in Group KP after intubation compared to baseline. DAP at 12 and 18 min, DAP and MAP at 24 min, SAP, DAP and MAP at 27 min, and SAP and MAP at 30 min after the start of the operation were significantly lower in Group P than in Group KP. The need for ephedrine and the number of patients who required ephedrine were significantly lower in Group KP than in Group P. Ketofol provided appropriate intubation conditions similar to propofol, without the use of a neuromuscular blocker, and contributed to better hemodynamic conditions in patients undergoing tympanomastoidectomy.

Estandarización de parámetros electrocardiográficos y presión arterial en caballos criollos de la Sabana de Bogotá

Antecedentes: los parámetros cardiovasculares en los caballos pueden variar entre razas y etapas fisiológicas, lo que dificulta la evaluación cardiaca. Objetivo: estandarizar parámetros electrocardiográficos (ECG) y de presión arterial (PA) en caballos criollos de la Sabana de Bogotá. Métodos: se emplearon 100 caballos entre machos y hembras divididos en 4 grupos de acuerdo con su edad (n=25): Grupo 1 (G1), entre 6 meses y 1 año de edad; grupo 2 (G2), entre 1 y 4 años; grupo 3 (G3), entre 4 y 10 años y grupo 4 (G4), mayores de 10 años. Se evaluaron derivaciones bipolares, unipolares y precordiales en ECG, así como en PA Sistólica (PAS), PA Media (PAM), y PA Diastólica (PAD) en todos los grupos. Resultados: 99 animales mostraron ritmo sinusal, entre los cuales se observó bloqueo anterior del fascículo izquierdo en una hembra de G2 y en una de G4; a su vez, una hembra del G3 presentó arritmia sinusal y en una del G2 se evidenciaron tres complejos ventriculares prematuros. La presencia de una onda P única y positiva, complejo QRS tipo QR y onda T bifásica fueron los más observados en todos los grupos. Una disminución significativa del eje cardiaco se observó en el G1 cuando se comparó con los demás grupos; además, el G1 presentó aumento significativo en valores de frecuencia cardiaca, PAS, PAM y PAD. Conclusiones: teniendo en cuenta las condiciones del medio y la forma en que la investigación se ejecutó, es posible concluir que los parámetros cardiovasculares de caballos criollos de la Sabana de Bogotá difieren con relación a su edad.

Clinical and laboratory peculiarities of combined clinical course of metabolic and articular syndromes

Aim. To identify clinical and laboratory peculiarities of a combined clinical course of metabolic and articular syndromes.&#x0D; Materials and Methods. In the research 126 individuals participated. They were arranged into 3 groups: the 1st group included 46 patients with comorbid pathology, the 2nd group – 44 patients with metabolic syndrome, and the 3d group – 36 patients with articular syndrome. The following parameters were evaluated: anthropometric data (height, body mass, body mass index, waist circumference), lipid spectrum, glycohemoglobin, nonspecific markers of inflammation, daily profile of arterial pressure.&#x0D; Results. In the group with comorbid pathology higher average values of body mass were recorded – 115.8 [60;140] kg in comparison with the 2nd and 3d groups – 93.5 [72;130] and 71.5 [58;98] kg, respectively; erythrocyte sedimentation rate – 18.3 [5;34] mm/h was reliably higher than in the 2nd group (11.5 [2;24] mm/h), and median cholesterol (6.18 [5,39;6,85] mmol/L) was higher than in the 3d group (4.82 [3,48;5,61] mmol/L). In the 1st and 2nd groups higher average values of systolic arterial pressure were recorded in comparison with the 3d group – 158,5 [120;190]; 154,6 [115;190] and 126,4 [96;168] mm Hg, respectively.&#x0D; Conclusions. In patients with combined metabolic and articular syndromes higher values of body mass and systolic arterial pressure were identified. Based on the laboratory findings, parameters of cholesterol and erythrocyte sedimentation rate were higher in patients with comorbid condition than in those with the isolated pathologies.

Clinical and laboratory peculiarities of combined clinical course of metabolic and articular syndromes

Aim. To identify clinical and laboratory peculiarities of a combined clinical course of metabolic and articular syndromes.&#x0D; Materials and Methods. In the research 126 individuals participated. They were arranged into 3 groups: the 1st group included 46 patients with comorbid pathology, the 2nd group – 44 patients with metabolic syndrome, and the 3d group – 36 patients with articular syndrome. The following parameters were evaluated: anthropometric data (height, body mass, body mass index, waist circumference), lipid spectrum, glycohemoglobin, nonspecific markers of inflammation, daily profile of arterial pressure.&#x0D; Results. In the group with comorbid pathology higher average values of body mass were recorded – 115.8 [60;140] kg in comparison with the 2nd and 3d groups – 93.5 [72;130] and 71.5 [58;98] kg, respectively; erythrocyte sedimentation rate – 18.3 [5;34] mm/h was reliably higher than in the 2nd group (11.5 [2;24] mm/h), and median cholesterol (6.18 [5,39;6,85] mmol/L) was higher than in the 3d group (4.82 [3,48;5,61] mmol/L). In the 1st and 2nd groups higher average values of systolic arterial pressure were recorded in comparison with the 3d group – 158,5 [120;190]; 154,6 [115;190] and 126,4 [96;168] mm Hg, respectively.&#x0D; Conclusions. In patients with combined metabolic and articular syndromes higher values of body mass and systolic arterial pressure were identified. Based on the laboratory findings, parameters of cholesterol and erythrocyte sedimentation rate were higher in patients with comorbid condition than in those with the isolated pathologies.

Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans.

The upright posture strengthens the coupling between heart period (HP) and systolic arterial pressure (SAP) consistently with a greater contribution of the arterial baroreflex to cardiac control, while paradoxically decreasing cardiac baroreflex sensitivity (cBRS). To investigate the physiological mechanisms that mediate the coupling between HP and SAP in response to different postures, we analyzed the cross-correlation functions between low-frequency HP and SAP fluctuations and estimated cBRS with the sequence technique in healthy male subjects during passive head-up tilt test (HUTT, n = 58), during supine wakefulness, supine slow-wave sleep (SWS), and in the seated and active standing positions (n = 8), and during progressive loss of 1 L blood (n = 8) to decrease central venous pressure in the supine position. HUTT, SWS, the seated, and the standing positions, but not blood loss, entailed significant increases in the positive correlation between HP and the previous SAP values, which is the expected result of arterial baroreflex control, compared with baseline recordings in the supine position during wakefulness. These increases were mirrored by increases in the low-frequency variability of SAP in each condition but SWS. cBRS decreased significantly during HUTT, in the seated and standing positions, and after blood loss compared with baseline during wakefulness. These decreases were mirrored by decreases in the RMSSD index, which reflects cardiac vagal modulation. These results support the view that the cBRS decrease associated with the upright posture is a byproduct of decreased cardiac vagal modulation, triggered by the arterial baroreflex in response to central hypovolemia. Conversely, the greater baroreflex contribution to cardiac control associated with upright posture may be explained, at least in part, by enhanced fluctuations of SAP, which elicit a more effective entrainment of HP fluctuations by the arterial baroreflex. These SAP fluctuations may result from enhanced fluctuations of vascular resistance specific to the upright posture, and not be driven by the accompanying central hypovolemia.

PP.06.07] HYPOTHALAMIC APOLIPOPROTEIN E EFFECTS ON ARTERIAL PRESSURE IN OBESE RATS WITH METABOLIC SYNDROME

Objective: The role of apolipoprotein E (ApoE) in the onset of metabolic syndrome remains unclear, ApoE being a key surface component of triglyceride-rich lipoproteins, low- and high density lipoproteins (VLDL, HDL) and also found in the hypothalamic area. This study researches the effect of ApoE on hypertension, associating increased combined ApoE at circulatory level to a hypothalamic ApoE deficiency, using a metabolic syndrome model in rats. Design and method: Wistar rats (male, 179–240 g, n = 10), on a high caloric, high fat diet (20 g/day/rat of fodder grain + pork lard as fat supplement 2 ml/day/rat) for 60 days, had measurements of their systolic arterial pressure (SAP), diastolic arterial pressure (DAP) values, weight and plasma lipid levels taken, days 0(T0), 60(T60) and 65(T65). Two groups (n = 20) of male Wistar rats (148g-220 g) on a normal caloric diet (20 g/day/rat ad libidum of combined fodder grain) and on the high caloric, high fat diet, were used as control. After showing raised SAP, DAP and lipid values (cholesterol range 158 – 170 mg/dl, triglycerides 201- 558 mg/dl, SAP 148–206 mmHg, DAP 98–150 mmHg)(T60) the rats were injected with 8 μl liquid ApoE (Millipore apolipoprotein E, Merck) in the hypothalamic area, 2.2 mm posterior to bregma and 7.4 mm ventral to dura. The procedure was performed under anesthesia (ketamine 10% + Xilazine 2%). Arterial pressure was measured using the tail-cuff method. Results: Mean value of SAP decreased from 183,62 (s = 27,22) (p < 0,007) before injection of ApoE to 181,87 (s = 23,44) (p < 0,38), while the control group injected with intracerebroventricular saline showed no decrease. Mean value of DAP decreased from 130,37 (s = 16,22) (p < 0,0004) to 121,37(s = 18,57)(p < 0,14).Conclusions: Preliminary data show the ApoE hypothalamic effects, that influence metabolic disorders and hypertension. Further study is highly necessary, yet we can conclude that deficient ApoE in the hypothalamic area can lead to raised SAP and DAP values.

HEMODYNAMIC AND MORPHOFUNCTIONAL ALTERATIONS OBSERVED FOR TEN YEARS IN YOUNG MALES OF MAGADAN REGION

The aim of the study was to reveal specific changes in somatometric and morphofunctional indices occurred in young males of Magadan with different arterial pressure in the period of 2004-2013. Statistically significant increase in systolic and diastolic arterial pressure was revealed for the studied period of 2004-2013. In addition to the above, the subjects examined in 2004, 2005 and in 2007, demonstrated no difference in arterial pressure while those examined in 2009 and the next two periods showed significantly higher values of systolic arterial pressure. The AP increase was associated with the body mass growth, body fat content and Pinije index value. The young males with NAP demonstrated more economical type of cardiovascular system functioning as compared to those with AH 1. It was found that, the level of arterial pressure can be considered as an informative marker of the Northman adaptation to the environmental extremes. It should be noted that, the best rate of adaptation is typical for 17-21 year-old individuals with the arterial pressure lying within the following dependence: 120/80 &lt; AP &lt; 130/85 mm Hg.

Agreement between two oscillometric blood pressure technologies and invasively measured arterial pressure in the dog

ObjectivesTo compare two commonly used oscillometric technologies for obtaining noninvasive blood pressure (NIBP) measurements and to determine if there is a difference in agreement between these systems and invasive blood pressure (IBP) measurements. Study designProspective, experimental study. AnimalsTwenty adult laboratory dogs. MethodsEach dog was anesthetized and its median caudal artery catheterized for IBP monitoring. An NIBP cuff was placed in the middle third of the antebrachium and attached to either monitor-1 or monitor-2. Four pairs of concurrent NIBP and IBP measurements were recorded with each monitor. Agreement between IBP and NIBP measurements was explored using Bland–Altman analysis, as well as the American College of Veterinary Internal Medicine (ACVIM) and Association for the Advancement of Medical Instrumentation (AAMI) guidelines for the validation of NIBP devices. ResultsBoth NIBP technologies produced results that met the ACVIM and AAMI guidelines for the validation of NIBP devices. For monitor-1, analyses of agreement showed biases of 0.2 mmHg [95% limits of agreement (LoA) -11.8 to 12.3 mmHg] in systolic arterial pressure (SAP) values, -2.6 mmHg (95% LoA -14.4 to 9.1 mmHg) in diastolic arterial pressure (DAP) values, and -2.5 mmHg (95% LoA -12.7 to 7.3 mmHg) in mean arterial pressure (MAP) values. For monitor-2, analyses of agreement showed biases of 3.4 mmHg (95% LoA -8.7 to 15.5 mmHg) in SAP values, 2.2 mmHg (95% LoA -6.6 to 10.9 mmHg) in DAP values, and 1.6 mmHg (95% LoA -5.9 to 8.9 mmHg) in MAP values. Conclusions and clinical relevanceMulti-function monitors can contain components from various manufacturers. Clinicians should consider whether these have been validated in the species to be monitored. Both of the technologies studied here seem appropriate for use in dogs.

Indirect arterial blood pressure measurement in healthy anesthetized cats using a device that combines oscillometry with photoplethysmography.

We investigated the basic characteristics of indirect arterial blood pressure (ABP) measurement using a device that combines oscillometry and photoplethysmography in cats. Dobutamine was infused intravenously in four anesthetized cats. Direct ABP was measured by a catheter. Indirect ABP was measured from the left forelimb. Dobutamine significantly elevated both systolic arterial pressure (SAP) and mean arterial pressure (MAP) in a dose-dependent manner. The indirect SAP, MAP and diastolic arterial pressure (DAP) values were closely correlated with the direct ABP values (r=0.88, 0.89 and 0.83, respectively). The mean bias for SAP, MAP and DAP was 3.4, 0.2 and −2.4 mmHg, respectively. The indirect ABP measured by this device may be used to reliably monitor ABP changes in anesthetized cats.

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation.

BackgroundHypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32–35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function.MethodsThe study included 30 patients who developed in-hospital cardiac arrest between September 17, 2012, and September 20, 2013, and had return of spontaneous circulation (ROSC) following successful CPR. Patient BTs were cooled to 33°C using intravascular heat change. Basal BT, systolic artery pressure (SAP), diastolic artery pressure (DAP), mean arterial pressure (MAP), heart rate, central venous pressure, cardiac output (CO), cardiac index (CI), global end-diastolic volume index (GEDI), extravascular lung water index (ELWI), and systemic vascular resistance index (SVRI) were measured at 36°C, 35°C, 34°C and 33°C during cooling. BT was held at 33°C for 24 hours prior to rewarming. Rewarming was conducted 0.25°C/h. During rewarming, measurements were repeated at 33°C, 34°C, 35°C and 36°C. A final measurement was performed once patients spontaneously returned to basal BT. We compared cooling and rewarming cardiac measurements at the same BTs.ResultsSAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). DAP values during rewarming (basal temperature, 34°C, 35°C and 36°C) were lower than during cooling. MAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). CO and CI values were higher during rewarming than during cooling. GEDI and ELWI did not differ during cooling and rewarming. SVRI values during rewarming (34°C, 35°C, 36°C and basal temperature) were lower than during cooling (P < 0.05).ConclusionsTo our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.

Comparison of the Haemodynamic Effects of Three Different Methods at the Induction of Anaesthesia.

Haemodynamic variations are inevitable during induction of anaesthetic drugs. The present study investigates the haemodynamic variations of three different drugs (thiopental, propofol, and etomidate) used for induction of general anaesthesia together with fentanyl. In a randomized, double-blind study, 45 patients were assigned to one of three groups (n=15 each). Fentanyl 1 μg kg(-1) was injected over 60 sec followed by propofol 2 mg kg(-1) (Group P), thiopentone 6 mg kg(-1) (Group T), or etomidate 0.3 mg kg(-1) (Group E). Noninvasive measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) was performed on admittance, immediately before the induction of anaesthesia, and 1, 3, and 5 min thereafter. Cardiac output (CO) values were recorded before induction, immediately after the injection of the drug, and at 1 min after the intubation. In all groups, during the study period, SAP, DAP, MAP, and CO values decreased with respect to time before induction. Following the administration of the induction dose of propofol (Group P), a significantly greater decrease of systolic and diastolic blood pressure was observed with etomidate (Group E) or thiopentone (Group T). Decrease in CO was also more marked with propofol (Group P) than with etomidate (Group E) or thiopentone (Group T). It's concluded that, in this study, the combination of fentanyl-etomidate is safer than both the groups of fentanyl-propofol and fentanyl-thiopental in terms of providing haemodynamic stability.

THE EFFECTS OF VIBROACOUSTICALLY-INDUCED MICROVIBRATIONS ON ARTERIAL BLOOD PRESSURE AND OXIDATIVE STRESS IN RATS

Abstract Vibroacoustics is a scientific field which has been intensively developed for the last thirty years; it uses the capabilities of sound (infrasound, ultrasound, noise and music) to induce vibrations, which, like a sound, may have useful or harmful effects. The aim of this paper was to examine the effects of vibroacoustically-induced microvibrations on arterial blood pressure and markers of oxidative stress in the rat blood. The experiments were done on Wistar male rats, 180-200 g body mass, divided into control and experimental groups (6 rats in each). In the experimental group, microvibrations were induced using vibroacoustic apparatus (the so-called phoning, Vitafon, St. Petersburg, Russian Federation ), with total of 60 min phoning time in 4 different application regimes, (5-minute-stabilization time, each 10-minute phoning regime each with 5-minute-breaks between single regimes, 30Hz-18000 kHz frequency rates and 2.8 μm-12.3 μm microwave amplitudes, kidney and liver phoning). After the completion of phoning experimental protocol, the animals were sacrificed and the values of oxidative stress markers were analyzed in blood samples (O 2 - , H 2 O 2 , nitrites, lipid peroxidation index, superoxide dismutase, catalase, glutathione) and compared with the values of markers in the control group. The analysis of values of systolic arterial pressure after acute application of different regimes of vibroacoustic microvibrations showed statistically significant decrease of systolic arterial pressure during the administration of the second regime in comparison to the control group. Systolic arterial pressure was found to return to nearly initial value after the application of vibrocoustic microvibrations in the third and fourth regimes. The analysis of values of diastolic arterial pressure after acute administration of vibroacoustic microvibrations in four different regimes did not show statistically significant decrease of diastolic arterial pressure in any regimes, although the pressure tended to decrease in the first and second regimes. Diastolic arterial pressure was found to return to nearly initial value after the administration of vibrocoustic microvibrations in the third and fourth regimes. The obtained results showed the occurrence of high statistically significant differences in catalase, while no statistically significant differences were found in relation to other analyzed parameters, although positive trend was observed after the phoning. Further research is necessary in order to define the applicative effects of low in regard to high frequencies of the vibroacoustically-induced microvibrations and physiological, i.e. possible therapeutic significance of the registered effects. Key words: vibroacoustics, arterial blood pressure, oxidative stress, microvibrations